This proposal is for University of Alabama at Birmingham School of Optometry (UABSO) to serve as one of 9 clinical centers in the Convergence Insufficiency Treatment Trial (CITT). The CITT is a multi-center clinical trial designed to compare the efficacy of two active treatment approaches for patients with convergence insufficiency (CI). In the proposed study, 392 patients between the ages of 9 and 30 years will be randomly assigned to: 1) office-based vision therapy/orthoptics, 2) placebo office-based vision therapy/orthoptics, 3) standard home based Pencil Push-ups, and 4) office-based Pencil Push-up therapy. Measurements of the signs and symptoms of CI will be made at baseline, and by masked examiners every 4 weeks during the 12-week treatment phase. Patients who are successful after 12 weeks of treatment will be followed for an additional 12 months. The primary outcome measure is the score on the Convergence Insufficiency Symptom Survey. Secondary outcome measures will include the near point of convergence and positive fusional vergence at near. Our objective at this Clinical Center will be to enroll at least 45 patients in the 24 month recruitment period. This application documents the ability of UABSO to recruit at least 45 patients during the 24 month recruitment period, and to retain patients who are successful after 12 weeks of treatment for one year after completion of treatment. Documentation is also provided that UABSO has the personnel, equipment, and facilities to conduct the study in accordance with the CITT Manual of Procedures (MOP). Complete details of the ClTT rationale, design, and methods are contained in the MOP, which is submitted separately with the Study Chair and Coordinating Center applications. In addition to UABSO, there will be 8 other optometric/ophthalmological clinical centers with the Study Chair in Philadelphia and the Coordinating Center at The Ohio State University Optometry Coordinating Center.